The relatively high fertility in Dangme West and Dangme East suggests low contraceptive use and hence the unmet need for family planning. The Ministry of Health and other health service providers should continue with efforts to make effective birth control methods not only accessible but also affordable. Analysis of current school attendance shows that the proportions of females in primary and junior high schools are slightly higher than those for males.

The sex differences at the senior secondary schools level however is in favour of males and widen at the tertiary level. The emphasis on girl child education is yielding dividends but there is room for improvement. The private informal sector plays a vital role in the economies of the districts.

Six out of every 10 economically active persons in the region are in the private informal sector. This high proportion in the informal sector points to lack of employment opportunities that compel people to create their own jobs which in turn often leads to fractionalisation of profits and a condition of shared poverty.

The private informal sector dominates the institutional sector in the region. In view of this, there is the urgent need for the district assemblies and central government to train and equip this large workforce with new skills to be able to participate effectively in the economies of their respective districts.

It should be possible for the private informal sector to access soft loans from banks for business. The ultimate objective would be to capacitate such businesses to transform into the private formal to provide job opportunities and make an impact on the economy.

Housing ConditionThe housing conditions situation leaves much to be desired. The toilet facilities accessible to households and the waste disposal methods, for both solid and liquid waste, point to a high level of unsanitary conditions, especially in AMA and Tema. Except at the Ridge, the Cantonments and educational institutions such as the Achimota College and the University of Ghana Legon, which were constructed with proper underground sewerage systems, the rest of the region has no proper interconnected sewerage system.

Only Tema Township was planned and constructed with a fully integrated sewerage system. Unfortunately, Tema has overgrown the capacity of the original system due to poor maintenance and lack of upgrading of the system. This has created problems similar to the situation in the AMA. An attempt to construct such a system between 1969 and 1971 for the Kaneshie and Korle Bu areas was abandoned after the 1972 coup d’etat.

The high cost of connecting housing units to the central sewerage system also discourages the implementation of the system. The drainage system in the AMA is very poor, resulting in annual flooding in spite of the low annual rainfall of the region. The open drains are supposed to serve as storm drains but have become receptacles for solid, liquid and human waste disposal. This situation, which has affected the efficient and hygienic disposal of solid, liquid and human waste in almost the entire region, needs to be seriously reviewed and addressed.

There is therefore the need for drastic measures to resolve once and for all the perennial sanitary and disposal problems of the region. AMA should enforce the byelaw that bans the use of pan or bucket latrine in the metropolis. The use of electricity as the main source of lighting in Dangme West and Dangme East is low. The low use of electricity may not be unrelated to the high cost of electricity. The proportion of households using charcoal as cooking fuel varies from 36.8 per cent in Dangme West to 61.1 per cent in AMA.

It is also noted that in Dangme West and Dangme East, more than half of households use wood as cooking fuel. In the face of depleting forest and little reforestation, cutting down trees to produce charcoal exacerbates the deforestation and land degradation problems.

To effectively address the issue of deforestation, District Assemblies should initiate and implement a vigorous tree planting exercise in their areas of jurisdiction. The sale of gas in smaller cylinders, which will be affordable to households, would need to be introduced to encourage the shift from wood- to non-wood- based fuel. This is because liquefied petroleum gas (LPG) is already heavily subsidised by government and to reduce it further may not be feasible under the present economic conditions.

The central government’s rural electrification programme has to be sustained so as to extend it to every nook and cranny in the country. The District Assemblies can contribute to the programme by mobilizing the communities to make financial contributions towards the purchase of electricity poles and cables. Government would need to address the issue of affordability of electricity.

Most households in the region rely on both orthodox medical and traditional health facilities for primary health care needs. Hospitals and clinics are not within easy reach of most communities, whereas traditional health facilities are fairly well dispersed and within easy reach of most communities.

The maximum distance from a locality to a traditional health facility is less than 5 kilometres while the maximum distance to a hospital ranges from 25 kilometres for Tema to 49 for Dangme West. The average population per doctor for the region is 2,968 while that for registered traditional healer is 1,207.

The good patronage of traditional healing facilities is evidence of easier accessibility and affordability than is the case with hospitals and clinics. The envisaged comprehensive health insurance scheme has gained a firm footing. The District Assemblies should collaborate with central government to build at least one well-equipped district hospital in Ga, Dangme West and Dangme East.

The major intervention in the area of education relates to access of females to education at the post secondary and particularly tertiary levels. Conscious efforts are required to close the male/female gap at the post secondary and tertiary levels through the adoption of an affirmative action programme. Affirmative action will ensure that some concession is granted female students at the tertiary level during admission.

Even though the region is well endowed with junior and senior secondary schools, some of which are among the best in the country, there is the need to guard against the proliferation of schools which could make room for the establishment of sub-standard schools. Two interventions emerge with respect to education facilities in the districts particularly Ga, Dangme West and Dangme East.

The Ministry of Education, Youth and Sports should vigorously pursue government’s initiative of upgrading at least, a senior high school into a centre of excellence in each district in order to close the wide gap in accessibility and academic performance between rural and urban schools. The second intervention relates to the cost of senior high school education. Increased government and private sector support for infrastructural development and equipment as well as viable scholarship and bursary schemes will go a long way to facilitate a much larger intake of students.